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New Patient Paperwork

Please click on the PDF link below to view the New Patient Packet forms, or right-click on the link to download the forms to your computer.

pdf   Download the New Patient Packet now >>

You can submit the forms to us in two ways:

  • 1. Bring the forms with you. You can print the forms and bring the completed forms with you when you come for your appointment with Dermatology Associates of Tampa Bay.
     OR
  • 2. Submit the forms via email. You can submit the forms via email.
    a. Download the forms to your computer
    b. Open the forms using Adobe Reader (or another PDF editor), complete the forms and save your changes
    c. Go to your email (e.g., Microsoft Outlook, OS X Mal, Mozilla Thunderbird, Gmail, Yahoo mail, AOL mail, etc) and mail the completed form as an attachment to hroedell@dermassociatesoftb.com.
NOTICE ABOUT EMAIL: Email is not a secure form of communication. This means that email may, for example, be intercepted, read, stored, or forwarded by third-parties. The Dermatology Associates of Tampa Bay cannot guarantee the security or confidentiality of information you send to us using email. By sending us email, you expressly assume the risk that the information you include and the forms you attach may be intercepted or otherwise improperly accessed by a third-party. Dermatology Associates of Tampa Bay shall not be liable for any breach of confidentiality resulting from such use of email or for information that is lost or misdirected due to technical errors or failures.

Please call 813-884-1626, or email hroedell@dermassociatesoftb.com with any questions or problems regarding these forms.

 
 
Phone: 813-884-1626